• 제목/요약/키워드: orthopedic treatment

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증등도 및 중증 무지 외반증 치료에서 원위부 갈매기형 절골술의 적용 (Distal Chevron Osteotomy for the Treatment of Moderate and Severe Hallux Valgus)

  • 윤준오;이호승;류석우;이기원;오세관
    • 대한족부족관절학회지
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    • 제7권2호
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    • pp.166-173
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    • 2003
  • Purpose: We assessed the treatment result of the distal chevron osteotomy in the patients with moderate to severe hallux valgus. Materials and Methods: In a total of 28 cases of hallux valgus in 20 patients, underwent distal chevron osteotomy between July 1999 and February 2001, were enrolled in this study. 21 cases were moderate and 7 cases were severe. The preoperative average hallux valgus angle and 1st-2nd intermetatarsal angle of the two groups were $31.5^{\circ}$, $15.8^{\circ}$ in moderate cases and $44.1^{\circ}$, $17.3^{\circ}$ in severe cases, respectively. Radiologic evaluation was done preoperatively, postoperatively and on the final follow-up visit using weight-bearing radiographic imaging to determine the hallux valgus angle and 1st-2nd intermetatarsal angle. Results: Radiographic evaluation revealed hallux valgus angle and 1st-2nd intermetatarsal angle in moderate cases to be $13.0^{\circ}$, $11.3^{\circ}$ (postoperatively and in severe cases $15.6^{\circ}$, $10.9^{\circ}C$, postoperatively. On final follow up, the results were $14.5^{\circ}$, $11.6^{\circ}$ in moderate cases and $18.3^{\circ}$, $11.9^{\circ}$ in severe cases, respectively. Conclusion: Distal chevron osteotomy can be usefully applied to the treatment of moderate to severe hallux valgus.

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Rotating Arm Internally Can Change the Arthroscopic Diagnosis of a Partial-thickness Tear of the Subscapularis

  • Kim, Hyungsuk;Song, Hyun Seok;Kang, Seung Gu;Han, Sung Bin
    • Clinics in Shoulder and Elbow
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    • 제22권3호
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    • pp.135-138
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    • 2019
  • Background: The aims of this study were (1) to examine the footprint of the subscapularis tendon using the traditional posterior portal and $30^{\circ}$ arthroscope by simple internal rotation of the arm during surgery, and (2) to classify the pattern of a subscapularis partial-thickness tear. Methods: This study analyzed a total of 231 patients with a partial-thickness subscapularis tear from 550 consecutive patients undergoing an arthroscopic operation who had a visualization of the subscapularis tendon footprint by internal rotation of the arm. First, the patients were classified into four categories according to the tear pattern: (1) stable lamination, (2) unstable lamination, (3) avulsion, and (4) laminated avulsion. Randomized arthroscopic videos were reviewed blindly by two independent orthopedic surgeons. The pattern of the tear of the subscapularis at the neutral position and after internal rotating the arm were assessed and compared with the treatment decision (level IV case series). Results: Stable lamination, unstable lamination, avulsion, and laminated avulsion were observed in 9.1% (n=21), 20.8% (n=48), 41.1% (n=95), and 29.0% (n=67) of cases, respectively. In 145 out of 231 cases (62.8%), the decision was changed after inspecting the footprint after internal rotation of the arm, and the treatment method was changed in 116 (50.2%) cases. Conclusions: In a subscapularis tendon partial-thickness tear, inspecting the footprint of the subscapularis tendon is essential to diagnosing and deciding on the appropriate treatment. In addition, simply internal rotating the arm during surgery when using the traditional posterior portal and $30^{\circ}$ arthroscope can be a valuable method.

Good functional results with open reduction and internal fixation for locked posterior shoulder fracture-dislocation: a case series

  • Nicolas Moran;Michael Marsalli;Mauricio Vargas;Joaquin De la Paz;Marco Cartaya
    • Clinics in Shoulder and Elbow
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    • 제25권4호
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    • pp.288-295
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    • 2022
  • Background: There is no standardized therapeutic strategy for locked posterior shoulder fracture-dislocation (PSFD), and no consensus exists on the analysis of preoperative factors. This retrospective study aimed to evaluate functional results and complications in a series of PSFD cases managed with open surgical treatment. Methods: Patients diagnosed with locked PSFD who underwent open surgical treatment with reduction and osteosynthesis between April 2016 and March 2020 were included. All participants were treated with open reduction and internal fixation. Functional assessment used the modified University of California, Los Angeles (UCLA) mod scale, American Shoulder and Elbow Surgeons (ASES) questionnaire, subjective shoulder value (SSV), and visual analog scale (VAS). Complications were evaluated clinically and radiologically by X-ray and computed tomography. Results: Twelve shoulders were included (11 patients; mean age, 40.6 years; range, 19- 62 years). The mean follow-up duration was 23.3 months (range, 12-63 months). The UCLA mod, ASES, SSV, and VAS scores were 29.1±3.7, 81.6±13.5, 78±14.8, and 1.2±1.4 points, respectively. The overall complication rate was 16.6%, with one case of post-traumatic stiffness, 1 case of chronic pain, and no cases of avascular necrosis. Conclusions: Open surgical treatment of locked PSFD can achieve good functional results. A correct understanding of these injuries and good preoperative planning helped us to achieve a low rate of complications.

소아 상완골 원위부 골단의 골절 및 분리 (Fracture-Separation of the Distal Humeral Epiphysis in Children)

  • 구자웅;김세동;안종철
    • Journal of Yeungnam Medical Science
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    • 제8권2호
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    • pp.121-127
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    • 1991
  • 상완골 원위부 골단의 골절 및 분리 7례를 장기 추시하여 분석한 결과를 요약하면 다음과 같다. 세밀한 이학적 검사와 방사선 검사로 상완골 외과 골절이나 주관절 탈구와 감별진단이 필요하며, 정확한 진단에서 치료를 시도하는 것이 바람직할 것으로 사료된다. 치료는 골절의 정복 상태를 객관적이고 정확하게 평가할 수 있는 방법이 없어 어려우나 저자들의 경우 보존적인 치료로서 비교적 좋은 결과를 얻었다.

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경추의 도수치료와 기계적 견인이 경추 가동범위에 미치는 영향 (Cervical Range Of Motion Changes After Cervical Mobilization And Mechanical Traction)

  • 김형수;안목;형인혁;김은영;이해정;배성수
    • The Journal of Korean Physical Therapy
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    • 제16권4호
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    • pp.283-296
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    • 2004
  • Joint mobilization and mechanical traction are common treatment forms for mechanical cervical spine problem. The purpose of the study was to investigate the effectiveness of cervical mobilization and mechanical traction on active range of motion of cervical spine. Sixty volunteers, aged between 21 and 24 years (mean age 22), were recruited. Each subject was divided into one of three groups; mechanical traction, general coordinative manipulation, and mobilization group. Active range of motions in the cervical were measured before and after each treatment technique from each subject on the three occasions. In the cervical range of motion, all subjects regardless treatment technique showed significantly increasing ranges after applied treatment technique in all directions except extension and left rotation in the mobilization group.

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유리 근피부판을 이용한 만성 골수염의 치료 (The Free Musculocutaneous Flap in the Treatment of Chronic Osteomyelitis)

  • 정덕환;조창현;정기웅
    • Archives of Reconstructive Microsurgery
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    • 제8권2호
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    • pp.163-169
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    • 1999
  • Purpose : To evaluate the efficacy of free musculocutaneous flap in the treatment of chronic osteomyelitis with drain sinus. Materials and Methods : Eighteen patients (sixteen male and two female) whose average age was 42.6 years were followed for an average of 3.5 years after free musculocutaneous flap for chronic osteomyelitis with drain sinus tract. The period of time between the initial injury and this procedure was average 10.6 years. The patients had an average of 4.1 prior surgical procedure before it. Results : Sixteen(88.9%) of the eighteen free musculocutaneous flap survived, including thirteen of latisimus dorsi flap, three of scapular free flap with muscle, two of medial plantar flap with abductor muscle. Sixteen cases had no evidence of recurrence at follow up. Conclusion : Free musculocutaneous flap is an extremely successful and reliable procedure for the treatment of chronic osteomyelitis with drain sinus. This flap with microvascular anastomses is highly vascularized through its own intrinsic blood vessels, which has the advantage of obliterating dead space and providing improved vascularity to the relatively ischemic recipient site and covering the skin defect.

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골다공증성 족관절 골절 (Osteoporotic Ankle Fracture)

  • 이효범;김철현;김갑래
    • 대한족부족관절학회지
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    • 제27권2호
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    • pp.43-48
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    • 2023
  • The incidence of osteoporotic ankle fractures is increasing as the population ages. These fractures are becoming more common in clinical practice and require careful management because of the higher likelihood of developing complications than typical ankle fractures. The introduction of a method for measuring the ankle joint bone mineral density is a valuable tool for assessing the bone quality of the ankle joint. By evaluating the bone mineral density, healthcare professionals can better understand the extent of osteoporosis and the overall strength of the ankle joint. This information is crucial for determining the appropriate treatment for individual fractures. Several factors must be considered when deciding on the treatment for osteoporotic ankle fractures. These include the ankle joint bone mineral density, skin condition, any comorbidities the patient may have, and the patient's functional demands. Taking these factors into consideration allows healthcare providers to tailor the treatment plan to the specific needs and the circumstances of each patient. By applying the appropriate treatment, it is expected that the complications associated with osteoporotic ankle fractures can be minimized, and the prognosis for patients can be improved.

Arthroscopic Treatment of Septic Arthritis of the Shoulder: Technical Pearls to Reduce the Rate of Reoperation

  • Kwon, Ji Eun;Park, Ji Soon;Park, Hae Bong;Nam, Kyung Pyo;Seo, Hyuk Jun;Kim, Woo;Lee, Ye Hyun;Jeon, Young Dae;Oh, Joo Han
    • Clinics in Shoulder and Elbow
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    • 제23권1호
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    • pp.3-10
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    • 2020
  • Background: The aim of this study was to evaluate clinical experience with arthroscopic debridement for septic arthritis of the shoulder joint and to report on our patient outcomes. Methods: The retrospective analysis included 36 shoulders (male:female, 15:21), contributed by 35 patients (mean age, 63.8 years) treated by arthroscopy for septic arthritis of the shoulder between November 2003 and February 2016. The mean follow-up period was 14.3 months (range, 12-33 months). An additional posterolateral portal and a 70° arthroscope was used to access the posteroinferior glenohumeral (GH) joint and posteroinferior subacromial (SA) space, respectively. Irrigation was performed with a large volume of fluid (25.1±8.1 L). Multiple suction drains (average, 3.3 drains) were inserted into the GH joint and SA space and removed 8.9±4.3 days after surgery. Intravenous antibiotics were administered for 3.9±1.8 weeks after surgery, followed by oral antibiotic treatment for another 3.6±1.9 weeks. Results: Among the 36 shoulders, reoperation was required in two cases (5.6%). The average range of motion achieved was 150.0° for forward flexion and T9 for internal rotation. The mean simple shoulder test score was 7.9±3.6 points. Nineteen shoulders (52.8%) had acupuncture or injection history prior to the infection. Pathogens were identified in 15 shoulders, with Staphylococcus aureus being the most commonly identified pathogen (10/15). Both the GH joint and the SA space were involved in 21 shoulders, while 14 cases involved only the GH joint and one case involved only the SA space. Conclusions: Complete debridement using an additional posterolateral portal and 70° arthroscope, a large volume of irrigation with >20 L of saline, and multiple suction drains may reduce the reoperation rate.

아킬레스건 견열 골절의 수술적 치료 (Operative treatment of avulsion fracture of Achilles tendon)

  • 박성진;최남용;주인탁;나기호;송현석;김정호;하재도
    • 대한족부족관절학회지
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    • 제7권2호
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    • pp.258-262
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    • 2003
  • Avulsion fracture of the calcaneal tuberosity is an uncommon injury. Usually it occurs from indirect trauma, and can be seen in old patients with osteoporosis or in patients with diabetic neuropathy. Follow-up studies showed healing of the fracture in most cases, but skeletal deformity may develop in some cases. Therefore we should take plain X-ray evaluations in diabetic patients with foot and ankle pain, even though there have been no definite trauma history. Four cases of calcaneus avulsion fracture were treated operatively in diabetic patients, and reported.

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천골 거대 세포종의 치료 결과 (Treatment Outcomes of Sacral Giant Cell Tumor)

  • 공창배;이광열;송원석;조완형;고재수;전대근;이수용
    • 대한골관절종양학회지
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    • 제19권2호
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    • pp.43-49
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    • 2013
  • 목적: 천골에 발생하는 드문 질환인 거대 세포종의 치료 방법에 따른 특성과 예후에 대하여 알아보고자 하였다. 대상 및 방법: 1990년부터 2012년까지 천골의 거대 세포종으로 진단받고 본원에서 치료받은 7명의 환자를 대상으로 하였다. 결과: 평균 연령은 23.6세였고, 남자가 2예, 여자가 5예였으며 평균 추시 기간은 52.3개월(15-73개월)이었다. 5명의 환자에서 병소내 절제술을, 1명의 환자에서 변연 절제술을 시행하였으며 수술적 치료를 시행하지 않은 1명은 방사선 치료만 시행하였다. 방사선 치료만을 시행한 환자와 변연 절제술을 시행한 환자는 국소 재발 없이 추시 중이다. 그 외 병소내 절제를 시행한 5명 중 1예는 한 번의 수술로, 다른 두 예는 두 차례 수술 후 재발 없이 추시 관찰 중이다. 나머지 두 예는 추가 치료에도 병변의 진행을 보였다. 결론: 천골 거대 세포종 환자의 치료법으로써 병소내 절제는 신경학적 손상을 최소화하면서 종양을 치료할 수 있는 방법 중 하나가 될 것으로 판단된다. 또한, 수술적 치료가 어려운 경우 방사선 치료가 대안으로 사용될 수 있다고 생각된다.